Patients and healthcare providers across the globe have come to the realization that depending solely on hospital systems will no longer be a viable option. The government’s efforts to expand access” to care while limiting costs are like blowing up a balloon while simultaneously squeezing it. The balloon continues to inflate, but in misshapen form. I also believe there is a moral imperative to achieve universal health insurance coverage in our society.\n\nAlong the way, it’s also distorting demand, raising prices, and making us all poorer by crowding out other, possibly more beneficial, uses for the resources now air-dropped onto the island of health care. The problems I’ve explored in the past year hardly count as breakthrough discoveries—health-care experts undoubtedly view all of them as old news.\n\nSince charity care, which is often performed in the ER, is one justification for hospitals’ protected place in law and regulation, it’s in hospitals’ interest to shift costs from overhead and other parts of the hospital to the ER, so that the costs of charity care—the public service that hospitals are providing—will appear to be high.\n\nAnd many of the materials, machines, and even software programs used by health-care facilities must be licensed by state or federal authorities, or approved for use by Medicare; these requirements form large barriers to entry for both new facilities and new vendors that could equip and supply them.\n\nHow well can insurance companies and government agencies judge the value of new features that tech suppliers introduce to keep prices up? But the use of insurance to fund virtually all care is itself a major cause of health care’s high expense. For the last few decades the indemnity health insurance had been one of the most common health care policies that almost every American had owned.